Provider Demographics
NPI:1801062393
Name:JEFFREY, RENEE (LICENSED PRACTICAL N)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:LICENSED PRACTICAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 HARRIS PARK
Mailing Address - Street 2:APT D
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1140
Mailing Address - Country:US
Mailing Address - Phone:585-482-3061
Mailing Address - Fax:585-482-3081
Practice Address - Street 1:124 HARRIS PARK
Practice Address - Street 2:APT D
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1140
Practice Address - Country:US
Practice Address - Phone:585-482-3061
Practice Address - Fax:585-482-3081
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2624211164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse